US HIV Testing Recommendations And Health Insurance Coverage

HIV Testing guidelines and insurance coverage

Main Points To Know

HIV testing recommendations are integral to HIV treatment, prevention, and care. Knowledge of one’s HIV status is essential for preventing the spread of disease, yet 15% of people with HIV don’t know they’re infected. Studies reveal that individuals who learn they are HIV positive change their behavior to decrease the risk of HIV

Overall about half (46 percent) of nonelderly adults in the United States (U.S.) have ever been tested for HIV, including 8 percent in the previous year. The CDC HIV testing recommendations suggest routine HIV screening in health-care configurations for many adults, aged 13-64, and repeat testing for people at higher risk.

Early knowledge of HIV status is vital for linkage to medical care and treatment that could decrease morbidity and mortality and enhance the quality of life. Treatment guidelines advise starting antiretroviral treatment immediately when one is diagnosed with HIV.

People with HIV who contain an undetectable viral part as a consequence of antiretroviral therapy that is successful cannot sexually transmit HIV to others.

Most people with health insurance — both public and private — have access to HIV testing, often at no price. And, for people without insurance, HIV testing can usually be obtained at little or no cost in community service settings.

Statistics On HIV Testing

1. Among the over 1.1 million people with HIV in the U.S., an expected 15% don’t know they’re infected, and this share accounts for almost 40 percent of new transmissions. Studies reveal that those who discover they are HIV positive change their behavior to decrease the chance of HIV transmission.

2. Through earlier detection, increasing awareness of HIV status, and linkage to treatment and care, testing could play an essential role in addressing the U.S. outbreak.

3. As per CDC’s Behavioral Risk Factor Surveillance System (BRFSS), nearly half (46 percent) of U.S. adults, aged 18-64, listed ever having been examined for HIV, including 8% who reported being tested in the previous year.

4. HIV testing varies by age, race/ethnicity, state, along with other factors. By way of instance, Blacks and Latinos are more inclined to report new testing and having ever been examined for HIV than whites (e.g., 68% and 49% vs. 46%, respectively have been tested).

5. According to some 2014 survey of homosexual and bisexual men in the U.S., comparatively few reports being analyzed as frequently as is often advised. Seven in ten say they’ve been tested at some time in their lives, one in five say they had been analyzed within the past six months, and three in ten say they have never been examined for HIV, a share that increases to 44 percent among those under age 35.

6. Findings from a new CDC evaluation of a decade of analyzing data indicates that some people at risk for HIV aren’t getting tested as often as recommended.

Testing Tips and Necessities

The CDC suggests routine HIV screening in health-care settings for many adults, aged 13-64, and repeat testing at least yearly for people at higher risk. Per the CDC, people who may benefit from HIV testing recommendations annual screening include:

-Sexually active homosexual or bisexual men (some of whom might profit from more regular testing, like every 3 to 6 weeks )

-People who do sex with an HIV-positive partner

-Those that had over one partner since their last HIV test

-Used shared needles or works to inject drugs

-Have exchanged sex for drugs or money

-People who have another sexually transmitted disease, hepatitis, or tuberculosis

-Those who’ve had sex with someone who has engaged in some of the activities above or with somebody with an unknown sexual background

Certain factors are known to decrease the risk of HIV transmission, such as condom usage, antiretroviral treatment resulting in durable viral load reduction among people with HIV, which prevent further transmission and using pre-exposure prophylaxis (PrEP) among those at higher risk for HIV.

HIV testing is suggested for all pregnant women, and for any newborn baby whose mom’s HIV status is unknown. Treatment offered to pregnant HIV-positive women and to their babies for 4-6 weeks after delivery can reduce the risk of transmitting HIV to1 percent or less. HIV testing is recommended for anyone who has been sexually assaulted.

CDC recommends that HIV screening be voluntary, and opt-out (patient is informed that the test will be conducted and consent is inferred unless the patient declines) vs. opt-in (evaluation is offered to the individual that must explicitly consent to an HIV test, often in writing).

HIV testing is compulsory in the U.S. in certain instances, including for organ and blood donors; military applicants and active-duty personnel; state and federal prison inmates under specific conditions; and newborns in individual states. As of January 2010, HIV screening is no longer necessary for those wishing to immigrate to the United States or for refugees.

Is HIV Testing Covered By Health Insurance?

Most insurers now widely cover HIV testing, many without cost-sharing, in part because of the declaration by the United States Preventive Services Task Force (USPSTF), a self-governing board that evaluates the net benefit of preventative services and assigns a consequent letter grade (A-D). Under the ACA, any “A” orb” rated preventative services must be offered by most insurers without cost-sharing; additionally, traditional Medicaid programs, although not required to provide USPSTF services, they are incentivized to do that.

In 2013, the USPSTF gave HIV testing an “A” rating for many teens and adults, ages 15 to 65. It also provided an “A” grade to HIV screening for pregnant women. Both these recommendations were reaffirmed in 2019.

The current insurance policy landscape of HIV testing is as follows:

Personal Insurance

Most private plans cover HIV testing without cost-sharing. All programs created after the ACA was signed in 2010 must cover.


All Medicaid programs include “medically necessary” HIV testing, and many cover routine HIV screening.


In April 2015, after the 2013 USPSTF recommendation and a following National Coverage Determination, CMS extended Medicare coverage to cover yearly HIV testing for grantees ages 15-65 regardless of danger, and people outside this age range at increased risk without cost-sharing. Additionally, Medicare will pay for up to three tests for pregnant beneficiaries.


For those without insurance policy (or wishing not to use their insurance), HIV testing can be obtained at minimum cost in specific community-based settings (e.g., community health centers, standalone HIV testing sites, mobile testing clinics).

Testing Policies And Sites

HIV testing recommendations are provided at CDC-funded testing sites (accounting for over 3 million tests) and in other public and private settings, such as free-standing HIV counseling and testing centers, private physician offices, health departments, hospitals, STD clinics, and mobile testing units.

The final positivity rate at CDC subsidized test sites was 0.9% in 2017, including testing amongst those recently and earlier diagnosed. The positivity rate for further diagnoses was 0.4 percent but was considerably higher for certain sub-populations (e.g., 3.2 percent for black men who have sex with men).

Among CDC-funded testing sites, non-health care centers have a higher rate of customers testing HIV-positive than do health care and correctional facilities.  All states/territories have prompted HIV name reporting (along with reporting AIDS cases) where an individual’s name is published to the state if they test HIV positive.

The condition then indicates the amount of unique positive HIV tests to CDC (no names or other personally identifying data are reported to CDC; just clinical and basic demographic information are forwarded). This is considered confidential HIV testing.

There’s also anonymous HIV testing provided at some testing sites where identifying information isn’t collected.

Testing Methods

HIV testing recommendations aim to identify the virus by looking for signs of the body’s immune response (antibodies), genetic material from the virus (RNA), or proteins on the surface of the virus (antigens). Detectable antibodies often develop within 3-8 weeks after infection but may take longer.

The interval after the primary virus with HIV before detectable antibodies form is the “window period.” In 2010, the FDA authorized the first HIV test that detects both antigens and antibodies, a part of the virus that triggers the generation of antibodies.

In 2013, the FDA accepted the first rapid antigen-antibody evaluation, the initial test also to differentiate between acute and established HIV-1 infection. Tests for antigen support for earlier detection of HIV.

As they can detect the virus until the body has mounted a response. Even though there will still be a window period of approximately two weeks following the first infection, through which no test can detect the virus.

Nucleic acid tests or RNA, which identify the virus in the bloodstream are available, but not used for screening. The test may be used in situations where there has been a high-risk vulnerability to HIV and as a follow-up test to a positive antibody test.

The latest HIV diagnostics in the U.S vary depending on the type of specimen tested (serum, whole blood, or plasma; pee; oral fluid); how the sample is collected (blood draw/venipuncture; oral swab; finger prick; through urination); in which the evaluation is done (lab; point-of-care site; in-home); and how quickly results can be found (conventional or rapid).

The principal types of assessments are:

Traditional Blood Test: a blood sample is drawn by a health care provider, tested at a laboratory. Results can take less than an hour to several days.

Traditional Oral Fluid Test: Oral fluid sample obtained by a medical care provider, who swabs inside of the mouth, tested at a laboratory. Results can take a few days to two weeks.

Quick Tests: Whole blood finger prick or venipuncture; oral fluid plasma sample collected based on the complexity of rapid evaluation and specific administering test. Results: about 10 minutes. If the test is negative, no additional testing is required. If positive, the test has to be confirmed with a more specific test through the conventional method. Some tests are granted CLIA waivers, which allow them to be used outside traditional labs.

Home Tests: There are two certified home tests. One of which is done using a finger prick finger with a lancet, putting drops of blood treated card, and sent to a laboratory for testing. An identification number on the card is required when calling for results, counseling, and referral available by phone. Results can be available in approximately three days. The other is a quick oral-fluid test for home use. R: about 20 minutes. Both home tests may be obtained online and from drug stores.

Urine Test: The urine sample collected by a health care provider; tested at a laboratory. Results: a couple of days to two weeks.

Follow-up After The HIV Test

After an HIV test, individuals who test positive can expect a confirmatory analysis and guidance to HIV care and treatment. It’s considered the best system to start antiretroviral treatment as soon as possible following diagnosis.

Doing this helps the best possible clinical outcomes for the HIV positive person. Also, a prevention event, as once that individual has an undetectable viral load, they cannot transmit HIV to others.

People who test HIV negative but who are at high risk for the virus may be referred to supplementary prevention services. Such as PrEP, which can decrease the chance of HIV acquisition through sex by more than 90%.

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